Change IV tubing and needleless connectors every 96 hours Daily CHG bathing Change bed linens and gowns daily Do not draw routine blood cultures from central lines Appropriate hand hygiene upon entering and exiting every patient room ID: 776533
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HAND HYGIENE
LINE NECESSITY
Change IV tubing and needleless connectors every 96 hours
Daily CHG bathing
Change bed linens and gowns daily
Do not draw routine blood cultures from central lines
Appropriate hand hygiene upon entering and exiting every patient room
Can line be removed
Does patient have a peripheral line
Use Curos caps
on every port
and
every line
Scrub the hub (needleless connector) prior to accessing
Dressing clean, dry, intact & current
Dressing change Q7days and PRN
DRESSING
CLABSI
CUROS CAPS
SITE & LINE INSPECTION
TUBING & NEEDLELESS CONNECTORS
CHG BATHING
BLOOD CULTURES
Bundle
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Assess at least every shift:
Site and line inspection
Blood return
ADULT & PEDIATRIC
Slide2Assess Line Necessity Every Shift!
CLABSI
Bundle
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ADULT & PEDIATRIC
INDICATIONS:
Examples include but not limited to:
pharmacy link with full text
Vesicant or irritating medications
Total parental nutrition (TPN)
Peripheral parenteral nutrition (PPN)
Hemodialysis
Advanced hemodynamic monitoring
Lack of adequate peripheral access
Home infusion of medications
Policy #12004
ALTERNATIVES:
Peripheral IV (PIV)
Midline IV
Note:
If long-term line necessity is identified, transition to a PICC and continue CLABSI bundle.
LOCATIONS:
Consider patient condition and treatment needs:
Subclavian
Internal Jugular (IJ)
Femoral:
Frequently re-evaluate for alternative sites or line types
4. PICC:
Placement sites will vary based on age, but usually placed in arm
Slide3Place a Curos cap on every hub (needleless connector) and every access port for both central and peripheral lines.
Place a Curos cap on all peripheral line hubs (needleless connectors)
even if
a patient doesn’t have a central line!
Change Curos cap when accessing and with tubing changes.
Curos caps are
single use!
Must discard upon removal and apply a new Curos cap.
Scrub the hub for 10 seconds
in addition to Curos caps.
Once a Curos cap is removed, scrub the hub (needleless connector) with alcohol pads for 10 seconds prior to access and between each medication administration!
CLABSI
Bundle
Curos Cap On Every Hub, And Every Line, Every Time!
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NEW
WATCH VIDEO!
“Scrub The Hub For 10 Seconds Prior to Access and Between Each Medication Administration”
NEW
ADULT & PEDIATRIC
Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.
ADMINISTERING MEDICATIONS:
CUROS CAPS AND TIPS:
CVC & PIV LINES:
Slide4CLABSI
Bundle
Dressing change
frequency:
Once per week, and
PRN for visibly soiled or compromised dressings
Visibly
soiled/compromised
dressings:
Excess blood & bodily fluids
External contaminants
Skin breakdown
Label requirements:
initials & date dressing change was performed
Avoid
premature dressing changes:Wait the full week unless the dressing is compromised!Increased disruptions equals increased risk for infection!
Fluids underneath occlusive dressing create:
A medium for bacterial growth, and
Increase the risk for infection
During routine bathing:Always secure and protect dressingsIf a Biopatch is more than 50% saturated with blood/fluids:Perform a dressing change and replace the Biopatch.
Dressing application considerations:
Location & surface area
Skin texture & creasesHair growthTo improve adhesive contact use:Skin prep wipes Adhesive spraysTo prevent loose dressings:Monitor the edges Secure external portsIf dressing edges are peeled back into the clear window, a dressing change is required, otherwise dressing reinforcement is acceptable!
Dressing: Clean, Dry & Intact!
WATCH VIDEO!“Performing A Proper CVAD Dressing Change”
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Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.
ADULT & PEDIATRIC
NEW
NEW
INTACT
DRESSING
DRY
DRESSING
CLEAN
DRESSING
Slide5Assess
Signs & Symptoms Every Shift:
Erythema & Swelling
Drainage & Leaking
Pain & Burning
Itching & Infiltration
Cellulitis
Catheter secure/patent
Assess Line Migration:
Assess length (cm) of line outside the body with every dressing change
Blood Return:
Perform
blood return check
at least every shift!If No Blood Return Is Noted:Reposition and/or roll patient Troubleshoot line (confirm line is unkinked & unlocked)If clotted line is confirmed, call MD for an order of Cathflo (alteplase)Pediatrics:Pressure alerts: be aware of pressure alert frequencies signaling a line occlusion
Dialysis Catheters (Permanent): RNs must have demonstrated competency in order to flush any dialysis catheter lumensTrialysis Catheter/Pigtail (Temporary):Treat pigtail as a central line!Check blood return and flush pigtail every shift!RNs must have demonstrated competency to flush all other temporary dialysis catheter lumens
DIALYSIS LINES
CLABSI
Adult Guidelines:
Flush 8-10ml NS prior to access and between each med administration
Flush 20ml NS after blood draws & blood infusions
Pediatric Guidelines: Flush 5-10ml NS prior to access and between each med administrationFlush 10ml NS after blood draws & blood infusionsFlushing Technique:Flush using push-pause techniqueDetach syringe with positive pressure, clamp line and attach Curos cap
FLUSHING GUIDELINES
Bundle
Site & Line Inspection Every Shift!
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Trialysis Cath (Pigtail)
WATCH VIDEO!
“Administering Cathflo”
Attention!
Never Replace Dialysis White Caps with Green Curos Caps!
Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.
ADULT & PEDIATRIC
Slide6Every 24 hrs:
TPN, Lipids, Lorazepam
Every 12 hrs:
Propofol, Mannitol
Every 4 hrs:
Blood (or every 2 units whichever occurs first)
Policy #11958
Change IV tubing every 96 hours:
MaintenanceIntermittent PiggybackNote: Tubing should be changed anytime the line has been compromised (i.e. the line came apart from the IV and is dangling at the bedside)
Back Priming Method:If the primary IV bag and the IV piggyback are compatible (even multiple IVPBs) use back priming method instead of multiple secondary tubing!
CLABSI
Bundle
Needleless Connectors:
Change every 96 hours with IV tubing changes OR when
blood residual
remains
Do not remove or change needleless connector after drawing blood from line
Flush well after blood draw and only change needleless connector if and when blood residual remains
Note:
change needleless connectors when drawing blood cultures!
IV Tubing & Needleless Connectors!
WATCH VIDEO!
“Back Priming Secondary IV Tubing”
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BLOOD DRAWS
NEEDLELESS
CONNECTORS
TUBING INTERVALS:
NEEDLELESS CONNECTORS:
BLOOD DRAWS:
SECONDARY TUBING:
IV TUBING CHANGE:
Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.
ADULT & PEDIATRIC
Slide7CLABSI
Bundle
CHG BATHING!
WATCH VIDEO!
“CHG BATHING”
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CHG COMPATIBLE
PRODUCTS
ANTIMICROBIAL
ACTIVITY
BATHING PROTOCOL:
ANTIMICROBIAL ACTIVITY:
CHG COMPATIBILITY:
STRAGETIC USE OF WIPES:
DAILY USE & GUILDELINES:
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ADULT & PEDIATRIC
DAILY USE
of CHG wipes for all patients with:
CVC
’s/PICC’s/Dialysis lines/Accessed Mediports
&
ALL ICU patients
GUIDELINES
Do NOT flush wipes or leave them behind in patient rooms.
Do NOT use wipes on patients with a rash or an allergy to CHG.
May bathe patient prior to using CHG wipes.
Use CHG compatible bathing wipes (make sure to toss all used wipes in trash).
Bathe with CHG wipes in the order shown in the diagram (on back).
Use all 6 wipes:
Always bathe the body part associated with the CVC line first, then clean 6 inches of the line nearest the patient, then bathe the opposite limb.
Apply clean linens and gowns after CHG is dry.
CHG has antimicrobial activity that lasts for 24 hours.
Massage wipes firmly into skin.
Do NOT wipe off CHG wetness/moisture, allow CHG to completely air dry.
Only use CHG compatible barrier products and lotions.
CHG wipes are alcohol free and contain moisturizers.
Slide8Use all 6 wipes:
Always bathe the body part associated with the CVC line first, then clean 6 inches of the line nearest the patient, then bathe the opposite limb.
Slide9CLABSI
Bundle
Increased length of hospital stay
Misdiagnosis of hospital acquired infections
Increased costs
Unnecessary use of antibiotics
Practice Aseptic Technique:
Use CRMC’s triple cleanse procedure
Always draw blood cultures prior to initiation of any antibiotics
Lab Must Draw Cultures Whenever Possible:
Lab has a contamination rate of less than 1%! (nursing is at 6%!)
Blood Cultures!
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Peripheral Blood Cultures:
Draw peripheral blood cultures whenever possible
Central Line Blood Cultures:
Do not draw from central lines (due to high rates of contamination)
UNLESS
the physician is ruling out specific line infection
Wait 15 minutes between blood cultures that are pulled through a central line
Insufficient quantity of blood may give false results!
PROCESSES
: Step-By-Step Instructions On Back
WATCH VIDEO!Access the videos by scanning the barcodes with a smartphone or by clicking on the direct video links below.
ADULT & PEDIATRIC
CONSEQUENCES OF CONTAMINATION:
AVOID CONTAMINATION:
Drawing a Central Line Blood Culture
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Peripheral Blood Cultures
*Only perform if lab can’t draw blood cultures
Central Line Blood Cultures
*Not recommended unless a physician is specifically ruling out a line infection
Remove alcohol pad Place adaptor cap on aerobic bottlePress down to penetrate septumTransfer blood from patient to bottle
CLABSI
Bundle
WATCH VIDEO!
ADULT & PEDIATRIC
“Drawing A Central Line Blood Culture”
Access the videos by scanning the barcodes with a smartphone or by clicking on the direct video links below
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